Primary biliary cholangitis, dissolving small cholesterol gallstones in people who cannot have surgery, intrahepatic cholestasis of pregnancy, and some other liver conditions where bile flow is impaired.

Bile that is too rich in cholesterol both forms stones and irritates liver cells. Ursodeoxycholic acid dilutes the pool of harsher bile acids with a gentler one, reduces how much cholesterol the gut absorbs and the liver secretes into bile, and encourages the bile ducts to keep bile moving. Over months this can dissolve cholesterol stones and protect liver cells from bile damage.

Diarrhoea and loose stools, nausea, and less often stomach pain or a rash. Diarrhoea is the most common reason for lowering the dose.

It works slowly: dissolving gallstones takes many months and the stones can come back after stopping. It does not work on calcified or pigment stones, or where the gallbladder is not functioning. Separate it by at least two hours from antacids containing aluminium, and from cholestyramine, which bind it. Tell your doctor about inflammatory bowel disease or repeated biliary pain. It is a prescription medicine in Pakistan.